Usefulness of Bispectral index to detect extensive cerebral ischemia due to acute aortic dissection Stanford type A during thoracic endovascular aortic repair

Abstract

 A 64 year-old male underwent thoracic endovascular aortic repair against dissecting aortic aneurysm Stanford type B. Just after completing the procedure, acute bradycardia and hypotension occurred, and was diagnosed due to acute aortic dissection Stanford type A. About 30 min later, Bispectral index (BIS) had suddenly decreased following temporary elevation. Aortic angiography revealed dissection of the right brachiocephalic artery and left common carotid artery. Just after finishing repair of the cervical arteries and right internal carotid artery, left common carotid artery bypass, ascending aorta and total arch replacement were performed. Ten hours later, he was extubated in the intensive care unit. His Glasgow Coma Scale was 14 points and he had right hemiplegia. Head CT scan revealed that he had a hemorrhagic cerebral infarction in the left basal ganglia. This case suggested that BIS monitoring was useful to detect a complication of central nervous system during general anesthesia.